Istituto di Ingegneria Biomedica     
Ferrannini E., Camastra S., Gastaldelli A., Sironi A. M., Natali A., Muscelli E., Mingrone G., Mari A. Beta-Cell function in obesity: effects of weight loss. In: Diabetes, vol. 53 (Suppl 3) pp. S26 - 33. American Diabetes Association, 2004.
In nondiabetic subjects, obesity is associated with a modest expansion of Beta-cell mass, possibly amounting-according to the best available estimates-to 10-30% for each 10 kg of weight excess. Whether age of onset and duration of obesity, recent changes in body weight, and body fat distribution have any effect on -cell mass in humans is unknown. Both fasting insulin secretion and the total insulin response to oral glucose have the following characteristics: 1) they increase with BMI in an approximately linear fashion, 2) both fat-free and fat mass are significant positive correlates, and 3) BMI exerts a positive effect separate from that of insulin resistance (i.e., obesity may be a state of primary insulin hypersecretion). The mechanisms are currently unknown, though chronic small increments in plasma glucose may play a role. In contrast, dynamic properties of Beta-cell function, such as glucose sensitivity (i.e., dose-response function), rate sensitivity, and potentiation, do not appear to be substantially altered by the presence of obesity, body fat distribution, or insulin resistance as long as glucose tolerance is maintained. Weight loss, by diet or restrictive bariatric surgery, is associated with consensual decrements in insulin resistance and insulin hypersecretion. The latter, however, seems to be more persistent, suggesting that the postobese state may reproduce the primary insulin hypersecretion of the obese state. Malabsorptive bariatric surgery, in contrast, normalizes insulin sensitivity and abolishes insulin hypersecretion even before achievement of ideal body weight. Lipid-triggered messages from the gastrointestinal tract to the insulin target tissues and endocrine pancreas are the subject of intense investigation. Obesity is the hyperinsulinemic state par excellence. Indeed, the very first human study simultaneously showing the presence of hyperinsulinemia and insulin resistance was conducted by Rabinovitz and Zierler (1) in the forearm of obese subjects. Since then, countless studies have documented the extent and circumstances of the hyperinsulinemia of obesity using a variety of experimental techniques. There are, nevertheless, still areas of significant uncertainty and gaps of knowledge that limit a full understanding of Beta-cell function in obesity. This review, while concisely summarizing what is well known, will try to focus on the less well known and the open questions.
URL: http://diabetes.diabetesjournals.org/cgi/content/full/53/suppl_3/S26
Subject Review

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